Two weeks ago I received a letter from Judith. This led to the following correspondence, which, with her permission, I have reproduced here with just a few minor edits. Over the course of three emails, Judith unfolded a tragic tale, which reveals how a combination of symptoms, that has no medical explanation, might develop from the rekindling of childhood trauma.
I am in my fifties and have had IBS for about 8 years. It came on quite suddenly when my mum died unexpectedly and I found her. I really think it was the shock. I had all the IBS symptoms but my predominant bowel habit was constipation. Since October, a time of huge stress, peaking at Christmas, it turned into diarrhoea. Although I am learning to live with the IBS, and control the symptoms with a combination of dietary restriction and Imodium, I have a symptom that I am convinced is linked: that is severe breathlessness. My GP and the gastroenterologist said it was not possible for the two to be linked but they both occur together and if I clear the diarrhoea with Imodium the breathlessness improves as well. If I try to relax I can bring about some improvement, but I don’t feel that it is wholly to do with anxiety because having a large meal in a restaurant brings on the symptoms as well. All the tests for my heart and lungs are clear. Do you think that my IBS could adversely affect my breathing? . It is the symptom I struggle with most as it affects even simple daily tasks.
I was intrigued and wrote back
I have to disagree with your GP and Gastroenterologist. To me your symptoms make perfect sense, but only if viewed through the lens of what has happened. There is such a close correlation between your breathlessness and your diarrhoea. Your IBS started after a dreadful shock and both your recent bowel upset and your breathlessness came on ‘after a time of great stress’ and if you are able to relax, there is some improvement. When we experience the kind of life traumas that you have, our mind and autobiographical memory can tend to shut down to protect ourselves; it’s then our body that remembers and tells the tale.
Trauma is so frequently followed by unexplained bodily symptoms. What happens is that the trauma is registered and remembered by the amygdaloid nuclei in the brain stem which trigger bodily reactions via the autonomic nervous system while the cognitive systems in the frontal cortex become dormant and drift off line. Clearly something happened during the huge stress last year to turn your symptoms from constipation, which you could control to something that feels out of control, diarrhoea and breathlessness. Your combination of symptoms is unlikely to be related to any damage or inflammation in the body, it is generated by what happened and expressed as bodily reactions.
Why it should be brought on by a big meal is a big of a mystery, but did food or eating a lot have something to do with the context of what happened last year, or could it be that the increased visceral stimulation of a big meal was sufficient physical stress to trigger these brain stem responses?
I think you will find that being able to focus on something that allows you to relax and gives you a sense of identity and confidence (applied mindfulness) will help your body inhabit the here and how instead of the there and then and gradually let things drift back to mind where they can be tolerated and dealt with. You may gain some help with all this from a therapist who has experience in working with the mind body connection. One organisation I have found particularly helpful is PODS (Positive Outcomes for Dissociation Survivors), www.pods-online.org.uk. They have published a very helpful booklet called Trauma and the Body: Somatisation and Dissociation, which explains what you have experienced.
I should be very interested to learn of any more observations concerning the context and associations of your symptoms. Unfortunately our medical system tends to divide the body up and see illness as something wrong with organs. Illnesses like IBS are not necessarily like that and narratives such as yours can help many others.
Judith replied: I can give you a bit more background: I had a very difficult life with my mum and lived under a great deal of stress with her throughout my childhood and really up until she passed away. When she died and I found her it was such a dreadful shock and the IBS came on very suddenly, though the breathlessness was more gradual and I tried to ignore it, as I do with most troublesome things!
It got much worse last October when I had some routine tests for a mouth problem which showed a tumour in my sinuses and then I had to have some eye surgery. I was also in a bad relationship. Christmas was very stressful with family stuff and I had my car broken into. I work full-time and have other long standing health issues to content with. All fairly small things, but together made me feel very strung out.
For a large part of my life, food has always been a pressure, not least because I have Type 2 Diabetes but also because I had an eating disorder when I was young. To be honest, I know that I have firmly adopted the idea ‘in my head’ that a large meal brings on my symptoms, although it is physically very real.
I wouldn’t describe myself as anxious but am quite an intense person and I have gone through a lot of traumatic things, especially in my childhood, as have a lot of people. I do believe that such trauma has to pop up at some point, so your reply was really helpful to me.
Dear Judith, Thank you for the additional information and for giving me permission to publish your story anonymously. It all fits; the accumulation of ongoing stress last year, and your childhood trauma. Somatic symptoms are a kind of dissociation; they take our mind off what has happened and focus it on something more immediate. The tendency often starts with childhood trauma; in your case, it has a lot to do with your mum.
In her last e-mail, Judith wrote:
My mum had mental health problems, mainly depression, but she had a really difficult personality as well (both her parents were alcoholics). She didn’t work much so my dad worked two jobs so I was with her most of the time. Although I was an only child I certainly wasn’t a priority. She was very harsh and critical, she told me other children were prettier and would put me down. She punished me for the slightest thing. She would wait for my dad to go to work then would hit me. She always spoke about suicide and as a very young child I would walk home from school and wonder if she would be dead and if there would be a lot of blood! Dad didn’t have a lot of time for me, though I have a better relationship with him now. So, my childhood was really just a huge amount of tension and strain, worrying about my mum and the consequence of everything I did, even, for example, if I accidentally scuffed my shoes. She also constantly told me that if I ate this or that I would grow up to be fat, if I swallowed chewing gum I would die – it was constant, everything I did would have catastrophic consequences!
I remember being extremely anxious as a child about going out into the playground at school, about going to family gatherings, men with beards (!), being in a place where there wasn’t a toilet, going upstairs – all sorts of things. There were other frightening things: bullying, some sexual abuse from my aunt’s husband, being shown really scary things, my arm was broken, my hand burned and on one occasion I was hung from my neck which was so very painful.
I tried to kill myself when I was 14 with a huge amount of diazepam and shortly after that I started to have some major seizures. The epilepsy is now under excellent control. A major difficulty is that I developed a binge eating disorder and became very overweight. That too has resolved. I weigh much less but have had type 2 diabetes since I was 26, but can control this much better now.
Even as an adult my mum succeeded in putting me down about my abilities, my looks, my outfits. My mum couldn’t help how she was and I don’t blame her, but to be honest since she has passed away I have really become a very different and more confident person. I haven’t had many relationships but was in one last Christmas, but he was quite uncaring and emotionally cold/cruel. Stupidly, although I am a grown woman I found it all very difficult to weigh up whether his behaviour towards me was OK or not – but my brain won in the end and told me it wasn’t – which is why I am not longer with him!
I became a Christian when I was 21 and continue to draw a lot of strength from that, I have a stable job which I enjoy greatly. Apart from the IBS and breathlessness problem, I now have more good days. It would be good to learn more about how to leave the past in the past. I don’t dwell on things but am aware that sometimes I feel an underlying dis-ease.
Judith’s correspondence has touched me deeply. I am so grateful that she has felt brave enough to share her life story. It is unnecessary to comment further, except to say how glad I am that she has discovered sufficient strength to escape her past and turn her life around. I feel that things will only get better.
As a psychotherapist, perhaps I see more patients with severe trauma though I don’t advertise myself as a trauma expert. Or perhaps, as indicated by a recent case control study, life trauma is much more common as a precedent to IBS than is generally realised. If Judith’s story resonates with your own experience, do write to me ‘in confidence’ at The IBS Network as this would help make more doctors aware of Post Traumatic IBS and how people can be helped overcome it.
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Liz Taylor, physiotherapist, posted this useful comment to this post on Facebook
I have read this and as a physio specialising in respiratory care one thing crossed my mind. Diarrhoea, if it causes cramping and bloating and a meal that makes you full might restrict the normal movement of the diaphragm. This might affect the way you breathe and make you feel breathless especially when doing everyday tasks. I too have felt breathless when I’ve had bloating and diarrhoea. It may be that there is an element of dysfunctional breathing caused by gut symptoms and indeed that might also be aggravated by the life stresses experienced. The good news is that there are specialist physios who can help with this. They can help retrain the breathing and give advice to manage some of the breathing symptoms you have.
There are physios who specialise in this as I do. There’s a website physio therapy for hyperventilation (I hate the term hyperventilation it’s such a crude term) and the chartered society of physiotherapy have a website too where you might find some info. Dinah Bradley has written a good book on breathing pattern disorders that might be helpful too.
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Thank you for your comment, Liz. There is always more than one way of looking at a problem and more than one solution.
Best wishes, Nick
Hello sir! I am very interested in finding out more about this particular article regarding the somatic symptoms and dissociation etc- I’ve researched much text and your explanation comes closest to my particular symptoms. I have been plagued with digestive issues all of my life but at times they include a panic type focus on my bodily functions that interferes with all areas of my life: being close to my kids and husband, social situations as well as trying to qualify for Boston marathon- am frustrated- any help you could offer in expanding on this topic would be much appreciated( or , if time constrained, directing me to further information). Thank you so so much:)
Dear Mandy, Can I suggest you follow the links in this post. I found the books by Bessel van der Kolk (The Body Keeps the Score) and Babette Rothschild (The Body Remembers) particularly helpful. Also look up Carolyn Spring and PODS (Overcoming Dissociation Symptoms) for wonderfully helpful account and articles. Best wishes, Nick
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